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Federico S, Cacciante L, Cieślik B, Turolla A, Agostini M, Kiper P, Picelli A. Telerehabilitation for Neurological Motor Impairment: A Systematic Review and Meta-Analysis on Quality of Life, Satisfaction, and Acceptance in Stroke, Multiple Sclerosis, and Parkinson's Disease. J Clin Med 2024; 13:299. [PMID: 38202306 PMCID: PMC10779774 DOI: 10.3390/jcm13010299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/24/2023] [Accepted: 12/30/2023] [Indexed: 01/12/2024] Open
Abstract
Telerehabilitation (TR) seems to be a viable and feasible solution to face the rehabilitative challenges posed by neurological impairments and to improve patients' quality of life (QoL). This review aims to synthesize and analyze the evidence on the impact of physiotherapy intervention through TR on QoL in patients with stroke, Parkinson's disease (PD), and multiple sclerosis (MS), together with an evaluation of their satisfaction and technology acceptance levels. Through a systematic search of the literature and a screening process, treatment effects were assessed with meta-analyses using the standardized mean difference, setting the confidence interval at 95%. We included 28 studies in the review, which were analyzed for methodological quality, whereas 16 studies were included in the meta-analyses. The results suggest a significant improvement in QoL in patients who underwent TR. We were unable to perform analyses for satisfaction and technology acceptance outcomes due to insufficient data. Overall, motor TR has a positive impact on the QoL of patients with neurological diseases, especially in stroke patients; although caution is needed in the interpretation of the results due to the high heterogeneity found. For PD and MS, TR seems to yield comparable results to in-person treatment.
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Affiliation(s)
- Sara Federico
- Laboratory of Healthcare Innovation Technology, IRCCS San Camillo Hospital, 30126 Venice, Italy; (S.F.); (L.C.); (B.C.)
| | - Luisa Cacciante
- Laboratory of Healthcare Innovation Technology, IRCCS San Camillo Hospital, 30126 Venice, Italy; (S.F.); (L.C.); (B.C.)
| | - Błażej Cieślik
- Laboratory of Healthcare Innovation Technology, IRCCS San Camillo Hospital, 30126 Venice, Italy; (S.F.); (L.C.); (B.C.)
| | - Andrea Turolla
- Department of Biomedical and Neuromotor Sciences—DIBINEM, Alma Mater Studiorum Università di Bologna, Via Massarenti, 9, 40138 Bologna, Italy;
- Unit of Occupational Medicine, IRCCS Azienda Ospedaliero—Universitaria di Bologna, 40138 Bologna, Italy
| | - Michela Agostini
- Rehabilitation Unit, Department of Neuroscience, University—General Hospital of Padova, 35128 Padova, Italy;
| | - Pawel Kiper
- Laboratory of Healthcare Innovation Technology, IRCCS San Camillo Hospital, 30126 Venice, Italy; (S.F.); (L.C.); (B.C.)
| | - Alessandro Picelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37100 Verona, Italy;
- Canadian Advances in Neuro-Orthopedics for Spasticity Congress (CANOSC), Kingston, ON K7K 1Z6, Canada
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Sharififar S, Ghasemi H, Geis C, Azari H, Adkins L, Speight B, Vincent HK. Telerehabilitation service impact on physical function and adherence compared to face-to-face rehabilitation in patients with stroke: A systematic review and meta-analysis. PM R 2023; 15:1654-1672. [PMID: 37139741 DOI: 10.1002/pmrj.12988] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/27/2023] [Accepted: 04/05/2023] [Indexed: 05/05/2023]
Abstract
OBJECTIVES The purposes of this systematic review and meta-analysis were to (1) appraise the available evidence of telerehabilitation program effects on functional outcomes, adherence, and patient satisfaction compared to face-to-face programs after stroke; and (2) provide direction for future outcome measure selection and development for clinical research purposes. TYPE: Systematic review and meta analysis of randomized controlled trials. LITERATURE SURVEY MEDLINE, CINAHL, Embase, Scopus, Proquest Theses and Dissertations, Physiotherapy Evidence Database (PEDro), and Clinicaltrials.gov were searched for studies published in English from 1964 to the end of April 2022. METHODOLOGY A total of 6450 studies were identified, 13 were included in the systematic review, and 10 with at least 3 reported similar outcomes were included the meta-analysis. Methodological quality of results was evaluated using the PEDro checklist. SYNTHESIS Telerehabilitation demonstrated equivalency in outcomes across several domains and was favored compared to conventional face to face alone or when paired with semisupervised physical therapy on Wolf Motor Function performance score (mean difference [MD] 1.69 points, 95% confidence interval [CI] 0.21-3.17) and time score (MD 2.07 seconds, 95% CI -4.04 to -0.10, Q test = 30.27, p < .001, I2 = 93%), and Functional Mobility Assessment in the upper extremities (MD 3.32 points, 95% CI 0.90-5.74, Q test = 5.60, p = .23, I2 = 29% alone or when paired with semisupervised physical therapy). The Barthel Index participation measures of function demonstrated improvement (MD 4.18 points, 95% CI, 1.79-6.57, Q test = 3.56, p = .31, I2 = 16%). Over half of summarized study ratings were determined to be of good to excellent quality (PEDro score 6.6 ± 2.3 points). Adherence varied in available studies from 75%-100%. Satisfaction levels of telerehabilitation were highly variable. CONCLUSIONS Telerehabilitation can improve functional outcomes and promote therapy adherence after stroke. Therapy protocols and functional assessments need substantial refinement and standardization to improve interpretation and clinical outcomes.
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Affiliation(s)
- Sharareh Sharififar
- Department of Physical Medicine and Rehabilitation, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Hanieh Ghasemi
- Shahid Sadoughi University of Medical Sciences, School of Medicine, Yazd, Iran
| | - Carolyn Geis
- Department of Physical Medicine and Rehabilitation, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Hassan Azari
- School of Podiatric Medicine, Barry University, Miami Shores, Florida, USA
| | - Lauren Adkins
- University of Florida Health Science Center Libraries, Gainesville, Florida, USA
| | - Bailey Speight
- College of Health and Human Performance, University of Florida, Gainesville, Florida, USA
| | - Heather K Vincent
- Department of Physical Medicine and Rehabilitation, College of Medicine, University of Florida, Gainesville, Florida, USA
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Gutierrez-Arias R, González-Mondaca C, Marinkovic-Riffo V, Ortiz-Puebla M, Paillán-Reyes F, Seron P. Measures to ensure safety during telerehabilitation of people with stroke: A scoping review. J Telemed Telecare 2023:1357633X231181426. [PMID: 37321644 DOI: 10.1177/1357633x231181426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
BACKGROUND Measures used to prevent adverse events during the implementation of exercise sessions delivered via telerehabilitation can be varied, ranging from simple telephone monitoring to synchronous therapist-led sessions. However, this information is scattered in the literature, as evidence synthesis studies have only addressed the safety, satisfaction, and effectiveness aspects of exercise delivered via telerehabilitation. AIMS This scoping review aims to describe that measures are used to ensure safety during exercise sessions delivered to people with stroke through telerehabilitation, as reported by authors of primary studies. Secondarily, it describes the designs most frequently used to notify the effects of telerehabilitation and evidence level, the characteristics of the participants and type of stroke, and the characteristics of telerehabilitation. SUMMARY OF REVIEW A scoping review was conducted according to the Joana Briggs Institute (JBI) recommendations. A systematic search of MEDLINE (Ovid), Embase (Ovid), CENTRAL, and CINHAL was conducted from inception to August 2022, and a review of systematic review references on the topic. We included primary studies that enrolled adults with stroke who underwent exercise delivered via telerehabilitation. Two independent reviewers performed study selection and data extraction, and disagreements were resolved by consensus or a third reviewer. A qualitative analysis of the information was performed. One hundred seven primary studies (3991 participants) published between 2002 and 2022 were included. Most studies were case series (43%) and rated with an Oxford level of evidence of "4" (55.3%). Regarding randomized clinical trials, half included 53 or more participants (IQR 26.75 to 81). Most studies applied the exercises via asynchronous telerehabilitation (55.1%), of which only ten reported measures to avoid adverse events. Some of the measures included assessing the location where exercises are to be performed, only using a seated position, and using live warning systems that prevent or stop exercises when they are risky. CONCLUSIONS Reporting of measures implemented to prevent adverse events during exercise delivery via asynchronous telerehabilitation is scarce. Future primary studies should always consider reporting adverse events related to exercise delivery via telerehabilitation and strategies implemented to decrease the incidence of these unwanted safety events. REGISTRATION NUMBER INPLASY202290104.
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Affiliation(s)
- Ruvistay Gutierrez-Arias
- Departamento de Apoyo en Rehabilitación Cardiopulmonar Integral, Instituto Nacional del Tórax, Santiago, Chile
- Exercise and Rehabilitation Sciences Institute, Faculty of Rehabilitation Sciences,Universidad Andres Bello, Santiago, Chile
| | - Camila González-Mondaca
- Exercise and Rehabilitation Sciences Institute, Faculty of Rehabilitation Sciences,Universidad Andres Bello, Santiago, Chile
| | - Vinka Marinkovic-Riffo
- Exercise and Rehabilitation Sciences Institute, Faculty of Rehabilitation Sciences,Universidad Andres Bello, Santiago, Chile
| | - Marietta Ortiz-Puebla
- Exercise and Rehabilitation Sciences Institute, Faculty of Rehabilitation Sciences,Universidad Andres Bello, Santiago, Chile
| | - Fernanda Paillán-Reyes
- Exercise and Rehabilitation Sciences Institute, Faculty of Rehabilitation Sciences,Universidad Andres Bello, Santiago, Chile
| | - Pamela Seron
- Centro de Excelencia CIGES, Universidad de La Frontera, Temuco, Chile
- Departamento de Ciencias de la Rehabilitación, Facultad de Medicina, Universidad de La Frontera, Temuco, Chile
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Su Z, Guo Z, Wang W, Liu Y, Liu Y, Chen W, Zheng M, Michael N, Lu S, Wang W, Xiao H. The effect of telerehabilitation on balance in stroke patients: is it more effective than the traditional rehabilitation model? A meta-analysis of randomized controlled trials published during the COVID-19 pandemic. Front Neurol 2023; 14:1156473. [PMID: 37265467 PMCID: PMC10229885 DOI: 10.3389/fneur.2023.1156473] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/04/2023] [Indexed: 06/03/2023] Open
Abstract
Objective Telerehabilitation and telemedicine have gradually gained popularity. In 2019, the outbreak of COVID-19 started in Wuhan and then spread across the world. To date, most countries have opted to coexist with the virus. However, patients, especially those who have suffered a stroke, should take measures to avoid being infected with any disease as much as possible since any infectious disease can lead to adverse events for them. Telerehabilitation can be beneficial to stroke patients as they are less likely to be infected by the virus. In recent years, several studies on telerehabilitation have been conducted globally. This meta-analysis aimed to investigate the effects of telerehabilitation on the balance ability of stroke patients, compare the efficacy of conventional rehabilitation with telerehabilitation, explore the characteristics of telerehabilitation and conventional rehabilitation, and provide recommendations for rehabilitation programs in the context of the global pandemic. Methods We searched Pubmed, Embase, the Web of Science, and The Cochrane Library databases from 1 January 2020 to 31 December 2022 for randomized controlled trials published in English that evaluated the improvement of balance function in stroke patients after telerehabilitation and compared the differences between telerehabilitation (TR) and conventional rehabilitation (CR). The random-effects model was utilized to calculate mean differences (MDs) with 95% confidence intervals (CIs) to estimate intervention effects. Statistical heterogeneity was assessed according to the I2 values. The risk of bias was measured using the Cochrane risk-of-bias assessment tool. Results We included nine studies in the system evaluation, all of which were included in the pooled analysis. All outcomes in the experimental and control groups improved over time. The comparison between groups concluded that people who received the telerehabilitation intervention had a significant improvement in the Berg Balance Scale (MD = 2.80; 95% CI 0.61, 4.98, P < 0.05, I2 = 51.90%) and the Fugl-Meyer Assessment (MD = 8.12; 95% CI 6.35, 9.88, P < 0.05, I2 = 0) compared to controls. The Timed Up and Go test (MD = -4.59; 95% CI -5.93, -.25, P < 0.05, I2 = 0) and Tinetti Performance-Oriented Mobility Assessment-Balance (MD = 2.50; 95% CI 0.39, 4.61, P < 0.05) scored better in the control group than in the experimental group. There were no significant differences in other outcomes between the two groups. Conclusion Studies on changes in medical conditions during the COVID-19 pandemic also demonstrated that, for stroke patients, telerehabilitation achieves similar effects as the conventional rehabilitation model and can act as a continuation of the conventional rehabilitation model. Owing to the different equipment and intervention programs of telerehabilitation, its curative effect on the static balance and reactive balance of stroke patients may be different. Currently, telerehabilitation may be more conducive to the rehabilitation of patients' static balance abilities, while conventional rehabilitation is more effective for the rehabilitation of patients' reactive balance. Therefore, further studies are needed for investigating the difference in efficacy between varied devices and telerehabilitation programs. Further research is needed on static and reactive balance. In addition, such research should have a large body of literature and a large sample size to support more definitive findings based on the context of the COVID-19 pandemic. Systematic review registration CRD42023389456.
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Affiliation(s)
- Zhaoyin Su
- The First Clinical College of Medicine, Lanzhou University, Lanzhou, China
| | - Zhenxia Guo
- Department of Trauma Surgery, First Hospital of Lanzhou University, Lanzhou, China
| | - Weitao Wang
- The First Clinical College of Medicine, Lanzhou University, Lanzhou, China
| | - Yao Liu
- The First Clinical College of Medicine, Lanzhou University, Lanzhou, China
| | - Yatao Liu
- Department of Trauma Surgery, First Hospital of Lanzhou University, Lanzhou, China
- Department of Anesthesia Surgery, First Hospital of Lanzhou University, Lanzhou, China
| | - Wanqiang Chen
- Department of Rehabilitation, First Hospital of Lanzhou University, Lanzhou, China
| | - Maohua Zheng
- Department of Neurosurgery, First Hospital of Lanzhou University, Lanzhou, China
| | - Nerich Michael
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Shuai Lu
- The First Clinical College of Medicine, Lanzhou University, Lanzhou, China
| | - Weining Wang
- School of Stomatology, Lanzhou University, Lanzhou, China
| | - Handan Xiao
- The Second Clinical College of Medicine, Lanzhou University, Lanzhou, China
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